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Meta-Analysis
. 2021 Feb 18;2(2):CD011466.
doi: 10.1002/14651858.CD011466.pub2.

Fluid restriction in the management of transient tachypnea of the newborn

Neeraj Gupta  1 , Matteo Bruschettini  2 , Deepak Chawla  3
Affiliations
Meta-Analysis

Fluid restriction in the management of transient tachypnea of the newborn

Neeraj Gupta et al. Cochrane Database Syst Rev. .

Abstract

Background: Transient tachypnea of the newborn (TTN) is caused by delayed clearance of lung fluid at birth. TTN typically appears within the first two hours of life in term and late preterm neonates and is characterized by tachypnea and signs of respiratory distress. Although it is usually a self-limited condition, admission to a neonatal unit is frequently required for monitoring and providing respiratory support. Restricting intake of fluids administered to these infants in the first days of life might improve clearance of lung liquid, thus reducing the effort required to breathe, improving respiratory distress, and potentially reducing the duration of tachypnea.

Objectives: To evaluate the efficacy and safety of restricted fluid therapy as compared to standard fluid therapy in decreasing the duration of oxygen administration and the need for noninvasive or invasive ventilation among neonates with TTN.

Search methods: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 12), in the Cochrane Library; Ovid MEDLINE and electronic ahead of print publications, in-process & other non-indexed citations, Daily and Versions(R); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), on December 6, 2019. We also searched clinical trial databases and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials.

Selection criteria: We included randomized controlled trials (RCTs), quasi-RCTs, and cluster trials on fluid restriction in term and preterm neonates with the diagnosis of TTN or delayed adaptation during the first week after birth.

Data collection and analysis: For each of the included trials, two review authors independently extracted data (e.g. number of participants, birth weight, gestational age, duration of oxygen therapy, need for continuous positive airway pressure [CPAP], need for mechanical ventilation, duration of mechanical ventilation) and assessed the risk of bias (e.g. adequacy of randomization, blinding, completeness of follow-up). The primary outcome considered in this review was the duration of supplemental oxygen therapy in hours or days. We used the GRADE approach to assess the certainty of evidence.

Main results: Four trials enrolling 317 infants met the inclusion criteria. Three trials enrolled late preterm and term infants with TTN, and the fourth trial enrolled only term infants with TTN. Infants were on various methods of respiratory support at the time of enrollment including room air, oxygen, or nasal CPAP. Infants in the fluid-restricted group received 15 to 20 mL/kg/d less fluid than those in the control group for varying durations after enrollment. Two studies had high risk of selection bias, and three out of four had high risk of performance bias. Only one study had low risk of detection bias, with two at high risk and one at unclear risk. The certainty of evidence for all outcomes was very low due to imprecision of estimates and unclear risk of bias. Two trials reported the primary duration of supplemental oxygen therapy. We are uncertain whether fluid restriction decreases or increases the duration of supplemental oxygen therapy (mean difference [MD] -12.95 hours, 95% confidence interval [CI] -32.82 to 6.92; I² = 98%; 172 infants). Similarly, there is uncertainty for various secondary outcomes including incidence of hypernatremia (serum sodium > 145 mEq/L, risk ratio [RR] 4.0, 95% CI 0.46 to 34.54; test of heterogeneity not applicable; 1 trial, 100 infants), hypoglycemia (blood glucose < 40 mg/dL, RR 1.0, 95% CI 0.15 to 6.82; test of heterogeneity not applicable; 2 trials, 164 infants), endotracheal ventilation (RR 0.73, 95% CI 0.24 to 2.23; I² = 0%; 3 trials, 242 infants), need for noninvasive ventilation (RR 0.40, 95% CI 0.14 to 1.17; test of heterogeneity not applicable; 2 trials, 150 infants), length of hospital stay (MD -0.92 days, 95% CI -1.53 to -0.31; test of heterogeneity not applicable; 1 trial, 80 infants), and cumulative weight loss at 72 hours of age (%) (MD 0.24, 95% CI -1.60 to 2.08; I² = 89%; 2 trials, 156 infants). We did not identify any ongoing trials; however, one trial is awaiting classification.

Authors' conclusions: We found limited evidence to establish the benefits and harms of fluid restriction in the management of TTN. Given the very low certainty of available evidence, it is impossible to determine whether fluid restriction is safe or effective for management of TTN. However, given the simplicity of the intervention, a well-designed trial is justified.

PubMed Disclaimer

Conflict of interest statement

NG has no interests to declare.

MB has received research funding from an ALF grant (non‐profit ‐ Lund University) and the Crafoord Foundation (non‐profit) for research projects not related to Cochrane.

DC has no interests to declare.

Figures

1
1
Study flow diagram.
2
2
Figure 2. Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies.
3
3
Figure 3. Risk of bias summary: review authors’ judgements about each risk of bias item for each included study.
4
4
Figure 4. Restricted versus standard fluid management, Outcome 1.1: Duration of supplemental oxygen therapy
5
5
Figure 5. Restricted versus standard fluid management, Outcome 1.6: Need for invasive ventilation
1.1
1.1. Analysis
Comparison 1: Restricted versus standard fluid management, Outcome 1: Duration of supplemental oxygen therapy
1.2
1.2. Analysis
Comparison 1: Restricted versus standard fluid management, Outcome 2: Incidence of hypernatremia (serum sodium > 145 mEq/L) during and at end of intervention period
1.3
1.3. Analysis
Comparison 1: Restricted versus standard fluid management, Outcome 3: Incidence of azotemia (serum creatinine > 1.5 mg/dL) during and at end of intervention period
1.4
1.4. Analysis
Comparison 1: Restricted versus standard fluid management, Outcome 4: Incidence of hyperbilirubinemia requiring treatment by phototherapy
1.5
1.5. Analysis
Comparison 1: Restricted versus standard fluid management, Outcome 5: Incidence of hypoglycemia
1.6
1.6. Analysis
Comparison 1: Restricted versus standard fluid management, Outcome 6: Need for invasive ventilation
1.7
1.7. Analysis
Comparison 1: Restricted versus standard fluid management, Outcome 7: Incidence of noninvasive (nasal CPAP or nasal ventilation) respiratory support
1.8
1.8. Analysis
Comparison 1: Restricted versus standard fluid management, Outcome 8: Length of hospital stay
1.9
1.9. Analysis
Comparison 1: Restricted versus standard fluid management, Outcome 9: Cumulative weight loss at 72 hours of age (%)
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References

References to studies included in this review

Akbarian Rad 2018 {published data only}
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Stroustrup 2012 {published data only}
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